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NEW YORK (Reuters Health) -
Psychological cruelty to children from parents or caregivers can cause as much -
or even more - emotional damage than physical and sexual abuse, according to a
new U.S. study.

The diagnosis is being overlooked and undertreated compared to physical forms
of abuse, researchers say.

“When you look at symptom severity, there was no difference between the three
forms of maltreatment,” said Joseph Spinazzola, lead author of the
study.

Psychological trauma is different from “dysfunctional parenting,” where moms
or dads periodically lose their tempers.

“It’s sort of living in this situation where they’re not receiving any kind
of love or warmth and instead they’re receiving either hostility, threats or
impossible demands, almost as if they are an enemy or monster, a pathetic
unlovable creature . . . .,” said Spinazzola, executive director of The Trauma
Center at Justice Resource Institute in Brookline, Massachusetts.

The study used the National Child Traumatic Stress Network Core Data set to
analyze the cases of 5,616 youth with histories of psychological, physical or
sexual abuse.

The children were ages 2 to 10 at the start of the data collection, which
took place from 2004 to 2010. Forty-two percent were boys and 62 percent had a
history of psychological abuse.

The children and their parents or caregivers were interviewed by clinicians
and also answered questions about behavioral issues and trauma on
questionnaires.

All three groups of children had scores in the same general range for
so-called "internalizing problems," like social withdrawal, sadness, loneliness,
difficulty concentrating or sleeping, and symptoms like headaches or
stomachaches.

But children who had been psychologically abused were more likely to have
negative outcomes over the long-term than victims of physical or sexual abuse.

They were 92 percent more likely to have trouble with substance abuse, 78
percent more likely to be depressed, 80 percent more likely to experience
separation anxiety disorder and 92 percent more likely to be anxious, according
to a paper scheduled for an upcoming issue of the journal Psychological Trauma:
Theory, Research, Practice, and Policy.

Compared to children who had been sexually abused, the psychological abuse
group was also 65 percent more likely to have academic problems, 91 percent more
likely to engage in criminal activity, 47 percent more likely to injure
themselves and 147 percent more likely to have attachment problems.

“One thing that struck me was that, of the forms of trauma measured by this
core data set, psychological abuse was the most enduring form of maltreatment,”
Spinazzola said. “When psychological abuse co-occurred with the other two, the
presence of psychological abuse heightened the negative effects to a greater
magnitude than when they occurred in the absence of psychological
abuse.”

But psychological abuse is often overshadowed by physical and sexual abuse,
the researchers note. In one previous study, only 7.6 percent of psychological
abuse was reported to child welfare agencies. Other research found psychological
abuse was investigated only 36 percent of the time (compared to 53 percent of
physical abuse cases and 55 percent of sexual abuse).

“I think there’s a hesitancy to label a parent as engaging in psychological
abuse because of that fear of unfairly blaming a parent for just being human and
imperfect,” said Spinazzola.

Spinazzola said that while there have been improvements in educating child
welfare personnel to better recognize psychosocial abuse and neglect, more work
was needed.

“It’s a combination of sort of education and awareness both at the training
level for social workers and graduate training but also outreach to families.
Educating and supporting parents in how to effectively engage with children and
how to manage their own distress that can affect their ability to be effective
parents,” Spinazzola said.

Dr. Jill Glick, medical director of Child Protective Services at the
University of Chicago Comer Children's Hospital, called the research
“transformational.” Glick was not directly involved in the study, though she is
a colleague of study coauthor Bradley Stolbach.

“When you look at these children, you’re seeing the impact of it is so
significant and what’s happening to them gets lost in the (mix) of child abuse
and neglect,” Glick told Reuters Health.

She said the study was a wake-up call to better identify and diagnose
psychological abuse.

“This paper is telling us we need to have a public surveillance approach to
psychological maltreatment with agreed-upon definitions,” Glick said. “This is a
really good thing that we’re finally saying this is a terrible form of
maltreatment, probably much more common than we realized.”

A much-hyped new study, conducted with just 150 participants, calls for us to
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most incredibly, healthier hearts. But the truth is the jury is still out.
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